A study of colorectal malignancy pattern in Tirunelveli Medical College Hospital

INTRODUCTION: Cancers in all forms are causing about 12 percent of deaths throughout the world. Colorectal carcinoma is the one of the eight leading cancers account for about 60% of all cancer cases and deaths worldwide. Colorectal carcinoma remains a leading cause of morbidity and mortality in many developed countries. The scene is much worse in the third world countries like India due to absence of screening programs and basic tests like occult blood in stool, the disease is often diagnosed late in course of disease, and hence the outcome is very poor. In every year nearly 5,55,000 new cases of the colorectal carcinoma was diagnosed in developed countries. In India, the incidence of the colorectal carcinoma is low, compared to the western world. Highest incidence is observed in Bhopal and lowest in Delhi. Colorectal carcinoma is actually an eminently curable disease, provided that is detected at an appropriate stage and treated adequately. Early diagnosis is therefore the key to success with this disease. In India most of the patients present at an advanced stage due to absence of screening programs and lack of investigation facilities and because of illiteracy, especially in rural areas. AIM OF THE STUDY: 1. To study the incidence of carcinoma of large intestine admitted and treated in the Department of Surgery, Tirunelveli Medical College Hospital, Tirunelveli, according to 1) The age of the patients. 2) The sex of the patients. 2. To study the risk factors which predispose to colorectal carcinoma. 3. To analyse the various modes of clinical presentation of colorectal carcinoma in admitted patients. 4. To study the histological and morphological types of colorectal carcinoma in admitted patients. 5. To review the methods of management of colorectal carcinoma in our hospital and outcome. MATERIALS AND METHODS: The study includes 55 histologically proven cases of carcinoma of the large intestine (colorectal carcinoma) that were admitted in the Department of surgery, Tirunelveli Medical College Hospital, Tirunelveli, during the periods of 30 months from June 2005 to November 2007 those were admitted and treated in the various units of this hospital. Thorough evaluation of these patients was done clinically, radiologically and other relevant investigations were done in order to arrive at a confirmatory diagnosis. Those patients who did not undergo any definitive line of managements like surgery (or) investigations were excluded from our study. Most of the patients were treated surgically. The various modalities and factors involved in aetiopathogenesis, disease presentation and treatment with regard to prognosis and morbidity profile of the patients with colorectal carcinoma were analysed. CONCLUSION: This study involves a very small subset of patients with colorectal carcinoma. The peak incidence of colorectal carcinoma in our region is in fifth decade. According to the western study reports the peak incidence is in the seventh decade. Our study revealed a male preponderance with a male to female ratio of 1.2:1. High intake of fatty diet, smoking and alcoholism among the male population increase the risk of colorectal carcinoma in our region. In our study, the most of the patients were diagnosed in the late stage of the disease. Commonest clinical symptom was bleeding per rectum which was correlated with other studies. The commonest sign was anaemia. A palpable mass was present in 31% of our patients. 7 patients (12.72%) were admitted as an acute emergency with intestinal obstruction. The most common site of the tumour which produced intestinal obstruction was sigmoid colon and rectosigmoid (57.14%). The common macroscopic type of carcinoma was ulcerative type and the microscopic type was moderately differentiated adenocarcinoma. Emergency surgery was done in 7 patients, 4 patients were expired post operatively. So the mortality rate in emergency surgery was high. Some of our patients have to travel long distances for chemotherapy and radiotherapy and end up subsequently as defaulters of these adjuvant modalities. So surgery is often the only treatment given. Hence early diagnosis and surgical resection are the best options for better results in our region